Type 2 Diabetes

A Family Affair

Your children will become what you are; so be what you want them to be.— David BlyType 2 diabetes is one of the most common chronic illnesses in the United States, and the number of new cases continues to increase here, as well as around the world. Of the approximately 7.8% of Americans who currently have diabetes, 9 out of 10 have Type 2 diabetes. In the past, the onset of Type 2 diabetes typically occurred in middle age. But today, Type 2 diabetes is being diagnosed in young adults and even in children at alarming rates. Experts estimate that 1 of 3 children born in the year 2000 will develop diabetes at some point in their lifetime.

While Type 2 diabetes is largely influenced by environmental factors, genetics play a role, too. That may sound like bad news, but in fact, having a genetic predisposition to Type 2 diabetes does not guarantee that a person will develop it. To the contrary, knowing that one has a genetic predisposition means a person can be proactive about preventing it.

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If you are a person with Type 2 diabetes, you are in the perfect position to let your family members know that they have a higher risk of getting it, too. But – with all that you’ve learned about staying fit and managing your blood glucose levels with Type 2 diabetes – you’re also in a position to show them how to lower their risk and maybe even avoid getting it.

Family ties

Type 2 diabetes runs in families. That means that your family members, especially close relatives such as siblings and children, have a strong genetic tendency to develop Type 2 diabetes. The risk of your children developing diabetes is related to the age at which you were diagnosed. If you were diagnosed before age 50, your offspring have a 1 in 7 chance of developing Type 2 diabetes. If you were diagnosed after age 50, they have a 1 in 13 chance.

There is some research that suggests a child’s risk is greater when the parent with Type 2 diabetes is the mother. The risk for getting Type 2 diabetes goes up to about 50% if both parents have it. If an identical twin has Type 2 diabetes, the other twin’s risk is almost 3 in 4.

If you have Type 2 diabetes but can’t think of any relatives who have it, chances are you have some who don’t yet know they have it. About 25% of those who have Type 2 diabetes are unaware they are living with the disease. This is unfortunate, because the longer a person has high blood glucose levels, the higher the likelihood of his developing long-term diabetes complications such as nerve damage. You can help your family members avoid such problems by being aware of their higher risk for Type 2 diabetes and making it a topic of family conversations.

Other risk factors

Having a family history of Type 2 diabetes is not the only thing that raises a person’s risk of getting diabetes. Other risk factors include older age, obesity, and a sedentary lifestyle. Since some of these risk factors can be changed, your family members should be aware of what else is increasing their chances of developing Type 2 diabetes and what they can do to lower their risk.

Overweight and obesity. People who are overweight or obese have a higher risk of developing Type 2 diabetes; the degree of risk increases as body-mass index (BMI) increases. However, this risk can be lowered by making sustainable lifestyle changes that help to reduce one’s weight. If your family members are currently overweight or obese (and even if they’re not), they can likely benefit from the healthy meal planning that is recommended as part of your treatment plan for Type 2 diabetes. Help them help themselves by sharing what you’ve learned about making healthy food choices and paying attention to portion sizes, particularly when eating high-calorie foods.

Sedentary lifestyle. Low levels of physical activity have become common in the United States, not just among adults, but among children, too. The health benefits of physical activity are well documented and include improved sensitivity to insulin – or reduced insulin resistance. Since insulin resistance is associated with many health problems, including high blood glucose levels, reducing it has widespread effects in the body.

If you’re a parent of kids who aren’t very active, do what you can to encourage more activity. Limit their screen time, organize active family activities, and sign them up for sports or lessons that they enjoy. Set a good example by being active yourself, and model how to overcome setbacks, such as missing workouts because of sickness or bad weather.

Ethnic or racial background. People with certain ethnic or racial backgrounds are at higher risk of developing Type 2 diabetes. At present, it is known that the following groups have a higher-than-average risk:

Asian Americans

African-Americans

Hispanic Americans, with the risk being highest for those of Puerto Rican descent

While race and ethnicity are factors that cannot be changed, being aware of them as risk factors can encourage your family members to take care of any modifiable risks they may have sooner rather than later.

Gestational diabetes. Having had gestational diabetes – a type of diabetes that occurs during pregnancy and usually disappears once the baby is delivered – significantly raises a woman’s risk of developing Type 2 diabetes later in life. Having delivered a baby weighing more than 9 pounds also raises the risk, even if a woman was not diagnosed with gestational diabetes during her pregnancy.

Gestational diabetes is commonly diagnosed between 24 and 28 weeks of pregnancy and is treated with dietary changes, physical activity, and, in some cases, medicine for lowering blood glucose levels. Women who develop gestational diabetes during one pregnancy are at higher risk of developing it during future pregnancies. However, women who have had gestational diabetes can substantially lower their risk of developing Type 2 diabetes later on by following a program of healthy eating and regular exercise after pregnancy.

Just as gestational diabetes raises the risk of developing Type 2 diabetes for women, so does a family history of Type 2 diabetes raise the risk of developing gestational diabetes. The daughters of parents with Type 2 diabetes need to be aware of this risk as they approach childbearing age. In addition, a mother’s gestational diabetes increases the child’s future risk of developing Type 2 diabetes, so if you had gestational diabetes while pregnant, your child or children can benefit from that information.

High blood pressure. Having high blood pressure raises the risk of developing Type 2 diabetes. Your relatives, therefore, should ask what their blood pressure is when it’s measured during routine health visits and follow their health-care provider’s advice for lowering it or for maintaining a healthy blood pressure.

High cholesterol. People with Type 2 diabetes typically have a pattern of blood fat levels that includes high triglycerides, low HDL (“good”) cholesterol, and increased numbers of small, dense LDL (“bad”) cholesterol particles, which are more damaging to blood vessels than “normal” LDL cholesterol particles. This pattern of blood fats is also predictive of Type 2 diabetes and is known to raise the risk of heart disease. Your family members should therefore be aware of their blood fat levels and any risks associated with them.

Heart disease. The risk of cardiovascular (heart and blood vessel disease) is 2 to 4 times higher in people with diabetes than in the general population. If diabetes runs in the family, usually so does heart disease. That being the case, your family members should not only stay aware of any risk factors they may have for diabetes but also any that raise the risk of cardiovascular disease, including high blood pressure and abnormal blood fat levels (as described above).

Insulin resistance. Almost all people with Type 2 diabetes have insulin resistance, a condition in which the cells of the body resist the action of insulin. Normally, insulin is the “key” that allows glucose to enter the cells, where it can be used for energy (or stored for later). When the cells resist insulin, the pancreas produces and releases more insulin to overcome the resistance. As long as the pancreas can produce enough insulin, blood glucose levels remain normal. If it can’t, they rise, potentially leading to a diagnosis of prediabetes or Type 2 diabetes.

Insulin resistance likely starts long before Type 2 diabetes is diagnosed. If it could be identified and addressed, a person might never develop Type 2 diabetes. Currently, there is no readily available test for diagnosing insulin resistance, but having a large waist is often a sign of it. In fact, some studies suggest that waist circumference is a better predictor of diabetes risk than BMI, because visceral fat, which accumulates within the abdomen, has more negative effects on health than subcutaneous fat, or fat that collects just beneath the skin. Visceral fat is often associated with an “apple-shape” body, as opposed to a “pear-shape” body, in which fat accumulates primarily in the hips and buttocks.

Aerobic exercise, such as brisk walking, can reduce visceral fat, even when no significant weight loss occurs.

Polycystic ovary syndrome. Usually called PCOS, this common female endocrine disorder is thought to affect 5% to 10% of women of reproductive age and to be one of the leading causes of infertility in women. Because PCOS is associated with obesity and insulin resistance, it is considered a risk factor for Type 2 diabetes. In fact, Type 2 diabetes is 5 to 10 times more common in women with PCOS than it is among women in the general population.

Symptoms of PCOS include infertility, menstrual irregularities, excess body and facial hair, acne or oily skin, and acanthosis nigricans, or patches of thickened and dark brown or black skin.

Prediabetes. People whose blood tests show blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes are said to be at risk for Type 2 diabetes or to have prediabetes (see “When Is It Diabetes?”). However, even in these individuals, developing Type 2 diabetes is not inevitable. With increased physical activity, the adoption of healthy eating patterns, and a weight reduction of 5% to 10% of body weight, blood glucose levels can be brought back to normal.

Making a difference

You can’t change your family’s genes, but you can help your family members recognize their risk for Type 2 diabetes. One resource you can point them to is a short quiz developed by the American Diabetes Association (ADA) that can be found on the ADA’s Web site. (See “Online Risk Evaluator” for the address.)

Your relatives should also tell their health-care providers about their family history of Type 2 diabetes and discuss when to be tested for it. Adults of any age who are overweight and have any other risk factors should be tested for diabetes. Adults with no risk factors should be tested initially at age 45 and, if those test results are normal, at least every three years afterward. When an adult has risk factors for diabetes but normal blood glucose levels upon testing, a doctor may choose to retest more frequently than every three years.

Encourage your relatives to be proactive in their efforts to minimize their risks for Type 2 diabetes. It is well recognized that increased physical activity, healthy food choices, and sustained weight reduction improve insulin sensitivity, therefore decreasing insulin resistance. These positive lifestyle behaviors also lower blood pressure and improve blood fat levels, which additionally can help to lower the risk of heart disease.

In your enthusiasm to help your relatives improve their health, however, make sure you don’t become the “prediabetes police.” Don’t nag or lecture. Instead, lead by example, by engaging in regular physical activity, preparing healthful meals, keeping your medical appointments, and staying informed. Invite your family members to join you in your efforts, if possible, and support them in the efforts they are ready to make. With awareness, information, and conversation, you can make healthy living your family legacy, instead of Type 2 diabetes.

Laura Hieronymus is a diabetes nurse specialist with over 25 years experience in the area of diabetes care and education. She is a Medical Information Senior Specialist with Amylin Pharmaceuticals, Inc., from Lexington, Kentucky. Tommy Bertram is a retired retail pharmacist from Albany, Kentucky. He is also Laura’s dad and mentor.

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